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Oka S.,Kobe University | Muratsu H.,Nippon Steel Hirohata Hospital | Matsumoto T.,Kobe University | Kubo S.,Kobe University | And 4 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Purpose: This study aims to clarify the influence of surgical exposure on intra-operative soft tissue balance measurements using a new tensor in minimal incision total knee arthroplasty (TKA). Methods: Sixty patients with osteoarthritis of the knee received minimal incision TKAs. Twenty patients received a posterior-stabilized TKA using a quadriceps sparing approach, and the other forty patients, using a limited medial parapatellar (mini) approach. After femoral trial placement, soft tissue balance was measured using an offset type tensor at full extension and 90° of knee flexion, with the patella both laterally retracted and reduced. The joint component gap and varus imbalance were used to assess the difference in patellar position and surgical exposure. Results: At extension, the joint component gap and varus imbalance showed no statistical difference regardless of patellar position in either TKA. However, the joint component gaps decreased at 90° of flexion when the patella was laterally retracted in both TKAs. Additionally, a significantly smaller joint gap was observed in the quadriceps sparing TKA than the mini-TKA with a retracted patella at 90° of flexion. Varus ligament imbalances decreased with the patella laterally retracted at 90° of flexion in the quadriceps sparing TKA, not in the mini-TKA. Conclusion: Surgeons should be aware of the influence in surgical exposure of the joint gap and ligament balance during patella shift in minimal incision TKA. Level of evidence: III. © 2011 Springer-Verlag.


Matsumoto T.,Kobe University | Muratsu H.,Nippon Steel Hirohata Hospital | Kubo S.,Kobe University | Matsushita T.,Kobe University | And 2 more authors.
Journal of Arthroplasty | Year: 2011

Using a tensor for total knee arthroplasty (TKA) enabling soft tissue balance measurements with a reduced patellofemoral joint and femoral component in place, we examined the influence of preoperative deformity on intraoperative soft tissue balance during posterior-stabilized TKA at 0°, 10°, 45°, 90°, and 135° of flexion in 60 varus-type osteoarthritic patients. Despite more than 20° of preoperative varus deformity influencing intraoperative ligament balance in varus, joint gap showed no significant difference regardless of the amount of preoperative varus deformity. Accordingly, even in pre-operative severe varus deformed knees, gap balancing can be adjusted during PS TKA. © 2011 Elsevier Inc.


Saiki T.,Nippon Steel Hirohata Hospital
Otolaryngology - Head and Neck Surgery (Tokyo) | Year: 2011

We reported a hypoglossal neurinoma located in the left submandibular region. A 69-year-old female visited our hospital with the chief complaint of a swelling of the left submandibular region. Paralysis and atrophy of the tongue were not exhibited. During the operation, it was recognized that the tumor was occurred in the left hypoglossal nerve anatomically and electrophysiologically. Intracapsular enucleation was performed as gently as possible. Post-operative hypoglossal nerve paralysis has not been observed immediately after surgery. Histopathological examination revealed neurinoma contained the Antoni A and B type. Postoperative course was uneventful until the time this report.


Watanabe F.,Nippon Steel Hirohata Hospital
Otolaryngology - Head and Neck Surgery (Tokyo) | Year: 2011

We reported a rare case of granular cell tumor of the vocal cord. A 57-year-old male visited our hospital with the chief complaint of hoarseness. Endoscopic examination revealed a yellowish and whitish mass in the inferior part of the right vocal cord with severe dysplasia of both vocal cords. The mass was excised by laryngomicrosurgery and diagnosed as a granular cell tumor. Postoperative course was uneventful.


Sakaki M.,Nippon Steel Hirohata Hospital
Otolaryngology - Head and Neck Surgery (Tokyo) | Year: 2011

A 42-and a 22-year-old females visited our hospital with the chief complaint of bilateral nasal obstruction. The smooth surface, milky and white colored elastic soft masses were located in the right nasal cavity of the case 1 and the left of the case 2. In each case, those tumors were successfully excised by endoscopic sinus surgery. Their origins were in the nasal septum in the case 1 and the lateral wall of the left nasal cavity in the case 2. Pathological diagnosis of each case was neurinoma. The postoperative courses of those cases were uneventful until the time of this report.


Nakanishi Y.,Nippon Steel Hirohata Hospital
Japanese Journal of Clinical Ophthalmology | Year: 2010

Purpose : To report a case of malignant lymphoma who showed ocular symptoms mimicking VogtKoyanagi-Harada (VKH) disease. Case : A 57-year-old male was referred for impaired visual acuity in both eyes. He had been diagnosed with VKH disease 4 weeks before. Pulse therapy with systemic corticosteroid was futile. He had received surgery for brain tumor 16 months before. Findings : Corrected visual acuity was 0.06 right and 0.2 left. Fluorescein angiography showed leakage and pooling of dye through the retinal pigment epithelium. Optical coherence tomography showed serous detachment. The findings were compatible with the diagnosis of VKH disease. Subtenon injection of triamcinolone acetonide and systemic cyclosporine resulted in improved visual acuity and persistent intraocular inflammation. It then became apparent that the brain tumor was malignant lymphoma. He started to show signs suggestive of tumor necrosis and died 7 weeks after his initial visit. Conclusion : This case illustrates that malignant lymphoma may masquerade as VKH disease and that due attention is needed to this possibility.


Nagai T.,Nippon Steel Hirohata Hospital
Japanese Journal of Clinical Ophthalmology | Year: 2010

Background : Hereditary angioneurotic edema (HANE) is caused by complement activation of inherent deficiency of Cl inhibitor. Gene polymorphism of deficient C1 inhibitor has been reported in relation to age-related macular degeneration (AMD). Purpose : To report a case of HANE who developed unilateral AMD. Case : A 69year-old male presented with impaired visual acuity in the right eye since 9 months before. He had been diagnosed with HANE with positive hematological findings before. Findings : Corrected visual acuity was 0.9 right and 1.0 left. The right eye showed subretinal fibrovascular proliferation in the paramacular area. He was diagnosed with AMD after visual acuity in the right eye deteriorated to 0.4 seven months later. Visual acuity improved to 1.0 fourteen months later following photodynamic therapy and intravitreal injection of ranibizumab. The left eye showed normal findings except paramacular drusen throughout. Conclusion : There is a possibility that complement activation by C1 inhibitor deficiency was associated with the onset of AMD in the present case.


Muratsu H.,Nippon Steel Hirohata Hospital | Matsumoto T.,Kobe University | Kubo S.,Kobe University | Maruo A.,Nippon Steel Hirohata Hospital | And 3 more authors.
Clinical Biomechanics | Year: 2010

Background: We developed a new tensor for total knee arthroplasty enabling the soft tissue balance measurement after femoral trial placement with the patello-femoral joint reduced. The purpose of the present study is to compare the measurements of joint gap and ligament balance between osteotomized femoral and tibial surfaces in posterior-stabilized total knee arthroplasty with that between surfaces of femoral trial component and tibial osteotomy. Methods: Using this tensor, the effect of femoral trial placement on the soft tissue balance was analyzed in 80 posterior-stabilized total knee arthroplasties for varus osteoarthritic knees. Both joint gap and varus ligament imbalance were measured with 40 lb of joint distraction force at extension and flexion, and compared between before and after femoral trial placement. Findings: In assessing the joint gap, there was significant decrease as much as 5.3 mm at extension, not flexion, after femoral trial prosthesis placement. Varus ligament imbalances were significantly reduced with 3.1° at extension and increased with 1.2° in average at flexion after femoral trial placement. Interpretation: These changes at extension were caused by tensed posterior structures of the knee with the posterior condyle of the externally rotated aligned femoral trial. At the knee flexion, medial tension in the extensor mechanisms might be increased after femoral trial placement with patello-femoral joint repaired, and increased varus imbalance. Accordingly, we conclude that intensive medial release before femoral component placement to obtain rectangular joint gap depending on the conventional osteotomy gap measurement has a possible risk of medial looseness after total knee arthroplasty. © 2010 Elsevier Ltd. All rights reserved.


Matsumoto T.,Kobe University | Muratsu H.,Nippon Steel Hirohata Hospital | Kubo S.,Kobe University | Matsushita T.,Kobe University | And 2 more authors.
Journal of Arthroplasty | Year: 2011

Using a tensor for total knee arthroplasty (TKA) designed to facilitate soft tissue balance measurements with a reduced patellofemoral joint, we intraoperatively compared the soft tissue tension of cruciate-retaining (CR) and posterior-stabilized (PS) TKAs performed at 0°, 10°, 45°, 90°, and 135° of flexion, with the patella both everted and reduced in 40 osteoarthritic patients. Although balance of soft tissue tension with a reduced patella of PS TKA slightly increased in varus from extension to flexion, these values slightly decreased for CR TKA from extension to flexion. Accordingly, we conclude that soft tissue tension patterns differ between everted and reduced patellae, as well as between PS and CR TKA. © 2011 Elsevier Inc.


Takayama K.,Kobe University | Matsumoto T.,Kobe University | Kubo S.,Kobe University | Muratsu H.,Nippon Steel Hirohata Hospital | And 4 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Purpose: The purpose of this study is to examine the joint component gap and its relationship with post-operative flexion angles in posterior cruciate-retaining (CR) total knee arthroplasty (TKA). In posterior-stabilized (PS) TKA, an inverse correlation between the joint component gap and the post-operative flexion angle was reported. However, the kinematics of the joint component gap has a different pattern in PS and CR TKA. It was hypothesised that CR TKA has a different correlation between the joint component gap and the post-operative flexion angle compared to PS TKA. Methods: The joint component gap was measured with an offset-type tensor. The joint component gaps were measured at 0°, 10°, 30°, 60°, 90° and 120° knee flexion angle and various values of the change in the joint component gap were calculated; 10°-0°, 30°-0°, 60°-0°, 90°-0° and 120°-0°. Multivariate regression analysis was used to determine the influencing of these parameters to post-operative knee flexion angle. Results: The post-operative flexion angle was positively correlated with a joint component gap of 90° and 120° and the values of the change in the joint component gap of 90°-0° and 120°-0°. Multivariate regression analysis demonstrated pre-operative knee flexion angle, and the values of the change in the joint component gap of 90°-0° had a significant independent factor of post-operative knee flexion angle. Conclusions: Post-operative flexion angle is multi-factorial. However, it is important to avoid flexion component gap tightness as well as excessive flexion component gap looseness for acquisition of better flexion angle in CR TKA. Level of evidence: IV. © 2011 Springer-Verlag.

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